Vitamin B 12 and the Hallelujah Diet. Summary Points. By Michael Donaldson, Ph.D.

Transcription

1 Vitamin B 12 and the Hallelujah Diet By Michael Donaldson, Ph.D. Summary Points How much do I need? Vitamin B 12 requirement is about 1-4 µg/week for healthy adults. What happens if I don t have B 12? Deficiency of vitamin B 12 leads to anemia and neurological disorders; deficiency in children can cause profound damage, much of which is reversible. A normal level of serum vitamin B 12 does not guarantee adequacy, methylmalonic acid concentrations (either serum or urine) are a much more reliable metabolic measure of vitamin B 12 metabolism. People following a pure vegetarian (vegan) diet are at high risk (>50%) for metabolic vitamin B 12 deficiency. Metabolic vitamin B 12 deficiency can be detected in as little as 22 months on the Hallelujah diet. It does not take a long time. Where do I get it in foods? Vitamin B 12 is found in all animal products (liver, muscle flesh, eggs, and dairy products are sources, in order from richest to poorest sources). Plant foods contain little if any active vitamin B 12 ; produce grown in soil fertilized with cow dung may contain more B 12 than commercially grown produce. Marine plant life (chlorella, dulse, nori, blue-green algae, spirulina) contain analogues of vitamin B 12 which can interfere with normal cobalamin metabolism; to rely on seaweed for vitamin B 12 is to lean on a splintered stick. Barleygreen does not supply sufficient amounts of vitamin B 12 for healthy adults. Bowel flora does not make enough vitamin B 12 for many healthy adults. Probiotic supplements are not a sufficient source of vitamin B 12 ; some products work better than others. How do I know I m getting enough? A simple urine assay for methylmalonic acid can determine metabolic cobalamin status.

2 What is the best supplement to use? Sublingual methylcobalamin is the best method for a person committed to a pure vegetarian diet to obtain their vitamin B 12. 1/2 of a Bio-Active B 12 tablet twice a week should be sufficient for a healthy adult.

3 Detailed Information How much do I need? The amount of vitamin B 12 required is very minute. As little as microgram (µg) per day (1-4 µg/week) is needed in a healthy adult (1). Stress, illness (especially involving the central nervous system), pregnancy, lactation, and rapid growth increase needs. The World Health Organization recommends 1 µg per day of vitamin B 12. The RDA for adults is 2.4 µg of vitamin B 12 per day, 2.6 µg during pregnancy, 2.8 µg during lactation, and proportionally less for children (2). Both have a significant margin of safety built into their recommendations. Unlike other B vitamins, B 12 is stored in the liver so daily consumption is not necessary. However, the normal uptake route of vitamin B 12 is saturated very quickly so that doses larger than 5 µg are poorly absorbed and are not more effective than smaller doses. A second uptake route, diffusion, allows about 1% of any dose to be absorbed (3). What happens if I don t consume vitamin B 12? Though the requirements are very low, deficiencies among vegetarians have been noted. There are at least 10 case reports in the medical literature of infants suffering severe neurological damage when solely breast-fed by their totally vegetarian mothers (4-15). Most of the damage is reversible by vitamin B 12 supplementation. Also, every study of vegan communities or populations has demonstrated low vitamin B 12 concentrations in percent of the group. Since many of these studies only measured serum cobalamin concentrations, they underestimated the number of people with metabolic deficiencies. This includes macrobiotic communities (16-20), natural hygienists (21), "living food" vegans (22), vegan Seventh Day Adventists (23-26), and followers of the Hallelujah diet. Our study revealed early signs of vitamin B 12 deficiency in 26 of the 54 people tested, after following the Hallelujah diet for as little as 2 to 4 years. Two important facts need to be noted. First, many, if not most, vegans have impaired vitamin B 12 metabolism. This has been verified time and again in vegan groups. Second, metabolic deficiency of vitamin B 12 can be detected after as little as 22 months on the Hallelujah diet. While serum vitamin B 12 levels may still be normal for several more years, the body, especially the central nervous system, may be deficient at the cellular level. 83% of the people in our study with metabolic vitamin B 12 deficiency had normal levels of serum vitamin B 12. These facts have not been widely appreciated by the vegetarian community. Based on the published studies and our results, adequate vitamin B 12 status of vegans cannot be taken for granted. Pregnant women, nursing mothers, infants, and small children are particularly vulnerable to B 12 shortages. Ensuring adequate B 12 is critical for normal neurological development and maintenance, with shortages resulting in permanent damage. Deficiency of vitamin B 12 leads to anemia and neurological abnormalities. Vegetarians' abundant dietary intake of folate masks much of the anemia due to vitamin B 12 deficiency. So the first signs of vitamin B 12 deficiency are neurological symptoms. These symptoms can include parathesia, especially numbness and tingling in the hands and feet, diminution of

4 vibration sense and/or position sense (usually but not always occurring first in the ankles and feet), unsteadiness, poor muscular coordination with ataxia, moodiness, mental slowness, poor memory, confusion, agitation, and depression. Delusions, hallucinations, and even overt psychosis (usually with paranoid ideas) may occur (27). By the time vitamin B 12 deficiency can be detected clinically significant neurological damage has already occurred and an aggressive supplementation program should be begun with methylcobalamin. Symptoms caused by a deficiency can usually be alleviated by vitamin B 12 supplementation. Healthy vegans with a healthy bowel flora should produce B 12 in their small intestine. This may be the natural way God intended for us to receive our vitamin B 12, but our study showed that this was not a reliable and sufficient source of B 12. All people produce B 12 in their colon, but this is not available for the body since B 12 is absorbed in the small intestine. Improving the bowel flora by using probiotic supplements (L. acidophilus, B. bifidus, etc.) may be helpful for supplying vitamin B 12. However, our study revealed that daily use for 3 months of either of two different brands of probiotics was not sufficient to restore people s vitamin B 12 status to normal. Where do I get vitamin B 12 in foods? The use of dulse, chlorella, nori, blue-green algae, spirulina, and fermented soy products have been promoted for their plant-based vitamin B 12 content. However, when some of these products were analyzed for true cobalamin activity, they were shown to contain almost all analogues of vitamin B 12 which are not active in the human body (1). In fact, some of these analogues interfere with normal cobalamin metabolism by competitive binding, resulting in poorer vitamin B 12 status. Serum vitamin B 12 levels may improve, while metabolic indicators deteriorate (28). Nori and spirulina have both been shown to be ineffective at improving vitamin B 12 status of children 28. It is not safe to rely on marine plant life or soy products for vitamin B 12. We see then, that dietary vegan sources of vitamin B 12 are very sparse since plant foods do not contain vitamin B 12 in appreciable amounts (1). There is some evidence that plants grown in soil fertilized with cow dung (rich in B 12 ) contain higher levels of B 12 within the plant (29). Whether the reported B 12 was true cobalamin and useful for people needs to be confirmed. Other vegan food sources include fortified breakfast cereals, fortified vegan products, fortified nutritional yeast, and dehydrated cereal grasses (like Barleygreen). The amount of B 12 in Barleygreen has been shown not to provide adequate amounts of B 12 for mature adults needs. Needs of infants and children are proportionally greater, so Barleygreen alone will not supply sufficient vitamin B 12 for a child. Nutritional yeast, (Red Star Vegetarian Support Formula) is fortified with an adequate amount of B 12 and is a good source of other B vitamins, trace minerals, and nucleotides as well. Many vegans have found this to be an acceptable and reliable source of vitamin B 12. What is the best supplemental form of vitamin B 12? Sublingual tablets or low dose sprays are the best delivery forms of B 12 supplements;

5 swallowed tablets are not as effective. The best, most bio-available form of cobalamin appears to be methylcobalamin (30). This form of B 12 (methylcobalamin) appears to be taken up by the body and used more efficiently than the more common cyanocobalamin. Cyanocobalamin is typically made by chemical synthesis, or by isolation from animal products or waste. The manufacturer will report the source of the vitamin if asked. Methylcobalamin is marketed by Enzymatic Therapy as "Bio-Active B-12" and is available from Hallelujah Acres. "Bio-Active B-12" is made from fermented plants and is an inexpensive, vegetarian product. 1/2 of a Bio-Active B 12 tablet twice a week should be sufficient for a healthy adult. If I had consumed very little vitamin B 12 in the last couple of years, I would take one tablet a day for ten days and then begin this maintenance program. How do I know I am getting enough vitamin B 12? A simple urine assay can be done through the mail with the Norman Clinical Laboratory, Inc. (Cincinnati, OH , $70). The urinary MMA assay is very specific for B 12 and much more reliable than a serum B 12 assay (31-35). If anyone has doubts about their B 12 status this is the lab test to order. Your physician can order this commonly available test for you as well. Conclusion There are many ways to get your vitamin B 12 but you must get it in your diet or ensure that your body makes it. You will not have excellent health without it. Please take this information to heart, take precautions, and keep all of this in eternal perspective. Set your affection on things above, not on things on the earth. For ye are dead, and your life is hid with Christ in God. When Christ, who is our life, shall appear, then shall ye also appear with him in glory. Col 3:2-5. References Abstracts can be accessed on PubMed, the National Library of Medicines free Medline search page: 1. Herbert, V Vitamin B-12: plant sources, requirements, and assay. Am J Clin Nutr 48: Yates, A.A., Schlicker, S.A. and Suitor, C.W Dietary Reference Intakes: the new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc 98: Kuzminski, A.M., Del Giacco, E.J., Allen, R.H., Stabler, S.P. and Lindenbaum, J Effective treatment of cobalamin deficiency with oral cobalamin. Blood 92: Ashkenazi, S., Weitz, R., Varsano, I. and Mimouni, M Vitamin B12 deficiency due to a strictly vegetarian diet in adolescence. Clin Pediatr (Phila) 26:

6 5. Cheron, G., Girot, R., Zittoun, J., Mouy, R., Schmitz, J. and Rey, J [Severe megaloblastic anemia in 6-month-old girl breast-fed by a vegetarian mother]. Arch Fr Pediatr 46: Grattan-Smith, P.J., Wilcken, B., Procopis, P.G. and Wise, G.A The neurological syndrome of infantile cobalamin deficiency: developmental regression and involuntary movements. Mov Disord 12: Hellebostad, M., Markestad, T. and Seeger Halvorsen, K Vitamin D deficiency rickets and vitamin B12 deficiency in vegetarian children. Acta Paediatr Scand 74: Higginbottom, M.C., Sweetman, L. and Nyhan, W.L A syndrome of methylmalonic aciduria, homocystinuria, megaloblastic anemia and neurologic abnormalities in a vitamin B12-deficient breast- fed infant of a strict vegetarian. N Engl J Med 299: Kuhne, T., Bubl, R. and Baumgartner, R Maternal vegan diet causing a serious infantile neurological disorder due to vitamin B12 deficiency. Eur J Pediatr 150: Lovblad, K., Ramelli, G., Remonda, L., Nirkko, A.C., Ozdoba, C. and Schroth, G Retardation of myelination due to dietary vitamin B12 deficiency: cranial MRI findings. Pediatr Radiol 27: Michaud, J.L., Lemieux, B., Ogier, H. and Lambert, M.A Nutritional vitamin B12 deficiency: two cases detected by routine newborn urinary screening. Eur J Pediatr 151: Sklar, R Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan- diet mother. Clin Pediatr (Phila) 25: Stollhoff, K. and Schulte, F.J Vitamin B12 and brain development. Eur J Pediatr 146: von Schenck, U., Bender-Gotze, C. and Koletzko, B Persistence of neurological damage induced by dietary vitamin B-12 deficiency in infancy [see comments]. Arch Dis Child 77: Wighton, M.C., Manson, J.I., Speed, I., Robertson, E. and Chapman, E Brain damage in infancy and dietary vitamin B12 deficiency. Med J Aust 2: Dagnelie, P.C., van Staveren, W.A., Vergote, F.J., Dingjan, P.G., van den Berg, H. and Hautvast, J.G Increased risk of vitamin B-12 and iron deficiency in infants on macrobiotic diets. Am J Clin Nutr 50: Dagnelie, P.C. and van Staveren, W.A Macrobiotic nutrition and child health: results of a population-based, mixed-longitudinal cohort study in The Netherlands. Am J Clin Nutr 59: 1187S-1196S. 18. Miller, D.R., Specker, B.L., Ho, M.L. and Norman, E.J Vitamin B-12 status in a macrobiotic community. Am J Clin Nutr 53: Schneede, J., Dagnelie, P.C., van Staveren, W.A., Vollset, S.E., Refsum, H. and Ueland, P.M Methylmalonic acid and homocysteine in plasma as indicators of functional cobalamin deficiency in infants on macrobiotic diets. Pediatr Res 36: Specker, B.L., Miller, D., Norman, E.J., Greene, H. and Hayes, K.C Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12. Am J Clin Nutr 47: Dong, A. and Scott, S.C Serum vitamin B12 and blood cell values in vegetarians. Ann Nutr Metab 26:

7 22. Rauma, A.L., Torronen, R., Hanninen, O. and Mykkanen, H Vitamin B-12 status of long-term adherents of a strict uncooked vegan diet ("living food diet") is compromised. J Nutr 125: Crane, M.G., Sample, C., Patchett, S. and Register, U.D Vitamin B12 studies in total vegetarians (vegans). Journal of Nutritional Medicine 4: Crane, M.G., Register, U.D., Lukens, R.H. and Gregory, R Cobalamin (CBL) studies on two total vegetarian (vegan) families. Vegetarian Nutrition: An International Journal 2/3: Haddad, E.H., Berk, L.S., Kettering, J.D., Hubbard, R.W. and Peters, W.R Dietary intake and biochemical, hematologic, and immune status of vegans compared with nonvegetarians. Am J Clin Nutr 70: 586S-593S. 26. Hokin, B.D. and Butler, T Cyanocobalamin (vitamin B-12) status in Seventh-day Adventist ministers in Australia. Am J Clin Nutr 70: 576S-578S. 27. Herbert, V. and Das, K.C Folic acid and vitamin B-12, pp in: Modern nutrition in health and disease Shils, M.E., Olson, J.A. & Shike, M. (eds.) Lea & Febiger, Philadelphia, Dagnelie, P.C., van Staveren, W.A. and van den Berg, H Vitamin B-12 from algae appears not to be bioavailable. Am J Clin Nutr 53: Mozafar, A Enrichment of some B-vitamins in plants with application of organic fertilizers. Plant and Soil 167: Monograph Methylcobalamin. Altern Med Rev 3: Allen, R.H., Stabler, S.P., Savage, D.G. and Lindenbaum, J Diagnosis of cobalamin deficiency I: usefulness of serum methylmalonic acid and total homocysteine concentrations. Am J Hematol 34: Matchar, D.B., Feussner, J.R., Millington, D.S., Wilkinson, R.H., Jr., Watson, D.J. and Gale, D Isotope-dilution assay for urinary methylmalonic acid in the diagnosis of vitamin B12 deficiency. A prospective clinical evaluation. Ann Intern Med 106: Matchar, D.B., McCrory, D.C., Millington, D.S. and Feussner, J.R Performance of the serum cobalamin assay for diagnosis of cobalamin deficiency. Am J Med Sci 308: Moelby, L., Rasmussen, K., Jensen, M.K. and Pedersen, K.O The relationship between clinically confirmed cobalamin deficiency and serum methylmalonic acid. J Intern Med 228: Norman, E.J. and Morrison, J.A Screening elderly populations for cobalamin (vitamin B12) deficiency using the urinary methylmalonic acid assay by gas chromatography mass spectrometry. Am J Med 94: